Class Programme Taster Workshop Booking Form Personal Details First Name Surname DOB (DD/MM/YY) Address Telephone No. Email Address Do you have any medical conditions, specific needs or access requirements that we should be aware of? Please give details. Emergency Contact Details Name Telephone No. Home Mobile Relationship to applicant Taster Class(es) attending Please return to heather.maclaurin@dancexhange.org.uk or DanceXchange Ltd. // Birmingham Hippodrome // Thorp Street // Birmingham // B5 4TB. T. 0121 689 3170 F. 0121 689 3170 // Company Limited by Guarantee // Company No. 2784677 // VAT No. 614 222 875. Registered Charity No. 1045364 // Registered in England & Wales